Hemostatic tonsillectome



Feb. 6, 1951 o. c. DANIELS, SR 2,540,936

HEMOSTATIC TONSILLECTOME Filed Feb. 24, 1949 1 2 Sheets-Sheet 1 NVENTOR.

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BY @J/ I M W a? Feb. 6, 1951 o. c. DANIELS, SR

HEMOSTATIC TONSILLECTOME 2 Sheets-Sheet 2 Filed Feb. 24, 1949 \A a W BY I z ZMWWCZ-DZ W W Patented Feb. 6, 1951 UNlTED STATES PATENT OFFICE HEMOSTATIC TONSILLECTOME Oscar C. Daniels, Sr., Oriental, N. G.

Application February 24, 1949, Serial No. 78,127

'7 Claims. (Cl. 128-309) The type of surgical instrument to which my present invention is applied is a tonsillectome adapted for the use of physicians and surgeons in the excision of tonsils and it has for its object to improve the mounting for the knife or cutter in conjunction with the hemostat blade and also to improve the arrangement of the elements by means of which the two blades are successively advanced, first to hold a tonsil in a'position separate from surrounding tissue and subsequently cause it to be severed.

Another object of my invention is to provide an improved retaining latch for limiting the retraction of the movable parts on the handle which also serves to yieldingly hold them in retracted position upon insertion of the instrument into the oral cavity of a patient and during the time the tonsil is being manipulated into the pillory.

To these and other ends my invention comprises furtherimprovements and advantages as will be further described in the accompanying specification, the novel features thereof being set forth in the appended claims.

' In the drawing:

Figure 1 is a perspective view of an instrument embodying my invention.

Figure 2 is a side elevation thereof.

Figure 3 is a rear elevation thereof.

Figure 4 is a top plan view of the instrument.

Figure 5 is an enlarged sectional view taken on the line 5-5 of Fig. 4.

Figure 6 is a view similar to Fig. 5 the hemostatic blade and knife blade being omitted,

Figure 7 is an enlarged cross sectional view of the pillory taken on the line 'l-'! of Fig. 4.

" Figure 8 is a side elevation of the hemostat blade showing one of its edge guides which also forms one of the guides for the knife blade.

Figure 9 is a top plan view thereof showing both of the double purpose guides.

Figure 10 is a fragmentary view showing the rear of the housing carried by the handle the blade operating parts having been removed therefrom.

Figure 11 is a side elevation of such blade operating parts removed from the handle.

. Figure 12 is a vertical sectional view taken on the line l2|2 of Fig. 10 and showing the latch-retarder;

Figure 13 is a plan view of the knife and its manipulator.

Figure 14 is a side elevation thereof, and- Similar reference numerals, in the several figures, indicate similar parts.

The instrument illustrated is capable of being operated in either the right or left hand of the surgeon and comprises a frame 28 carried at its rear end on a handle 2], and of a length suitable to reach the sides of the throat when inserted in a patients oral cavity while its outer end extends beyond the patients lips for easy access in manipulating the movable parts carried thereon. The frame has an upper face 22 which is flat and extends from the rear end of the instrument, at a point above the handle to the fenestra, or circular opening 23 at its forward extremity into which a tonsil is manipulated. The inner end of the frame constitutes a pillory and is made as thin as possible, yet of sufficient substance'to afford the requisite stability and provide the guides for the hemostat blade and the knife blade. As will be seen in Figs 5 and 6 the end of the frame surrounding the aperture 23 forms a rim comprising a lower portionz l and an upper portion 25 separated by a knife blade slot 26. The sides of the rim, indicated by 21, of this thickened end of the frame embrace the aperture 23 and extend in parallelism somewhat rearward of the opening 23, as shown in Fig. 4. The inner faces of these side portions 21 are undercut as indicated at 28 nearly to the point rep: resented by the rear edge of opening 23 to pro-'- vide guideways of greater width than said opening. The knife slot 26 extends into the guide ways to accommodate a knife blade having a cutting edge which exceeds the diameter of the pillory opening 23.

The instrument frame is provided at its rear end with a housing 30 which serves as a retaining guide for the two blades of the instrument. The housing is formed integrally with the frame 20 and is supported at one side of the face 22, as indicated at 3| in Fig. 10, and curves over said face but terminates above the face to provide a slot 32 through which the instrument blades may be inserted and removed by a sidewise movement. At its forward end the housing has an interior semi-circular shoulder 33 and projecting inwardly at its rear end is a stop shoulder 34.

The movable parts of the instrument comprise a hemostatic blade and a cutting blade with means for operating the former quickly to engage a tonsil in the pillory and enucleate it and additional means for subsequently advancing the cutter, said parts being all carried on the hemostatic part of the instrument.

Figur e lais an end view For the manipulator. Figures 8 and 9 show in detail the forward or pressure end of the hemostatic blade and Fig. 11 illustrates the operating parts carried thereon. It has a central arm which is fiat which lies parallel to the face 22 and is of the same width as the frame 20. At its forward end is a pressure plate 35 fitting between the sides 21 of the frame and rounded at its end to fit against the part 25. Pressure plate 36 has laterally projecting wings 31 fitting the guideways 28. The wings hold the forward end of the, arm 35 elevated to support the pressure plate above the plane of the knife slot 26 in the frame and are slotted, as indicated. at 38 in line with said slot. Extending forwardly from the guides is an element 39 which. supportsthe underside of the knife blade. It is shaped like the hemostatic blade but is slightly narrower and not quite so long, as shown dotted lines in Fig. 9.

At its rear end the arm 35 (see Fig. 11) liPI1l-i nates in a shoulder 40 and on its underside and forward of the shoulder is. a circular projection 41 the face of which liesin thdpl'ane ofthe guide wings 31'. It; rides onthe face 22: of the frame andmaintains the arm 35 parallel. thereto. On the. arm. 3.5, above the shoulder 58, is a boss. 45 which alines with the opening or aperture in, the housing defined by the arcuate stop 33. Av spin,- dle. 46d shown in dottedtl-ines in Fig. 1 1) is carried by boss; 45 having one; end rigidly secured thereto and its other end. extending through the other elements and threaded. to receive av locking nut. which serves as a..thum-b. pressure nut 52 and holds the elements against: longitudinal movement with respect. to blade: 35.. Spindle. tea

slidably receivesa second spindle. to (Figs. l and 2) onwhich't-here. is. fixed a sleeve: l! of a. diam,- eter which neatlyr engages with; an: easysliding fit. within the. housing 3EL its. inner end 48' being disposed to enga e. against. the. arcuate shoulder 3.3-inthe. housing, at: the time the: pressure plate 36?. contacts. the inner portion. of the. rim so on the. frame to prevent possible; distortion of said rim. Entrance of the sleeve. 41 into the housing in its: proper operating position is provided by a longitudinal. slot t9 cooperating with a guide; 345-. Atabout thetmid point of the. sleeve there leads a rearwardly extending spiral cam surface; 553 designed" to cooperate with. the inner end of: the guide 34 onthe'hous-ing for forcing: the; arm 35 forwardly; this movement. being initiated. by rotary'movem-ent imparted. to the. slcever'by a butterily or; wing" nut..5.l' fixed tothe outer end' of the spindle; The: rotary movement is: possible after the; straight portion; of the longitudinal: slot (see Fig. l) clears the guide .34. iu'the; forward movem nt of. sleeve;

The; pi e 4.6 isthreadedi etween. nut. 51- and sleeve. fiflsandz rotatable onthe thread isra. pilot wheel; 552. for advancing; and r tracti g the cutter for; which purpose. it. is provided." withan annular recessr56,

Anrim-portantobject. of; my invention resides: in the: means, for. mounting; the cutting; blade and manipulating it inconjunction. with the. hemestatic-blade whereby the parts. may be readily disassembled for'sterilization and with equal facility reassembled and new-blades quickly inserted i-fi needed b.etween;.operations I. useas the cutter in. thisinstrumeut a thin. flexiblesteel blade having a head 60' rounded on. its forward; edge and having parallel. lateraledges fitting in the 60 is a tail 6| of sufficient length. toreadily bend d wnwards nomssaidzguidesonto. the race roof the frame without interfering with the longitudinal movement of the head of the blade. The latter is advanced and retracted by a slide 62 to which it is connected by passing an aperture therein over a pin 63. Hooking these two parts together is facilitated by tapering the underside of the forward end of the slide upwardly so that it may be readily inserted beneath the end of the tongue 5| after the blade has been first inserted in, the guideways. 38. The slide 62, it will be observed, occupies the space between the frame face 22 and the underside of the arm'35 and is provided with 'a longitudinal slot 6 straddling the guide pin ti on said arm. There is also a channel 63 in the face 22 of the frame to accommodate the pin 63. At its rear end slide 62 extendsbeyond the. sleeve 27 on the spindle where it is provided with an upwardly extending flange 65 having a laterally opening slot as adapted to embrace the annular recess 56 on the hub of the pilot wheel. The. slide 52 is thin enough to provide: the, required flexibility to allowit-to; readily slip; over the pin 4!- when its rear end. is: placed sideways to. engage the flange 65 with. the pilot wheel and likewise to permit it to be sprung beneath said. pin when the slide is disconnected from said wheel.

It is essential in an instrument of. this character that it be capable of a. one. handed. operation and because the frame when inserted in a pa tients oral cavity is usually in a vertical position thatv the movable parts, be frictionally held retracted. It is to these ends therefore. that; I provide at the rear end, of the. frame a spring operated latch that performs the dual. functions: of limiting the rearward movement: ofthe; two-blades to set them in their initial operating: positionand alsoto frictionally retain them against accidental displacement during the manipulating of a tonsil intothe guillotine or pillorying. aperture.

Directly above the handle 2 and beneath the housing 30 the frame is slotted, as. indicated by it in Fig. 12,. to accommodate a lever 'lzl, pivoted at T2 and operatedupwardly by a coil. spring. [35. Upward movement of the lever when: the; blade elements are removed, is limited by a cross, pin 14 which will engage the lip 1-5 on the frame. For retracting the lever its free end is provided; with a thumb piece 76. On the upper edge of the. lever is a projection H which normally lies in the path of the-end shoulder 40 on the. arm 35 and limits the distance the hemostatic blade. and, the parts carried. thereby can be. retracted. This projection operates. through the slot 64 in the blade operating slide 62 and when its forward edge. engages the stop 49; its upper surfacerestsin engagement with. the. sleeve: .41, the; forward end. of the latter being; atthistime within. the housing 3.9., Topm vide the. desired frictional. contact: at. thistime'l taper the undersid of the. slecve'as indicatedat- 49 (Fig. 11) so that. when. the sleevev is pushed further into the housing 30 the latch isdepressed against the tension of its spring, 13. r

In performing a tonsillectomy the. patient. ispreferably in a prone position so that thedistal end of the instrument when. inserted in, the mouth may be positioned with the hemostaticv blade facing the tonsil which to be removed and said'end inserted between the tonsil and the.-

posterior pillor' for taking into the aperture 23 the lower pole or base of the tonsil. In this part of the operation it is possible to manipulate the shaft or instrument frame so as to permit an un-- obstructed view into: the patients throat and to liitzthetonsilout of its pectin; the sinus. tonsilauis.

"causing it to pass into the pillory aperture '23 with possible manual aid applied to the tonsil.

The above having been accomplished the application of pressure of the thumb upon the nut 52 will advance the hemostatic blade to dislodge the tonsil from its bed, the surgeon at this stage being careful to disengage any unwanted tissue. The advancing of the blade up to this point has positioned the cam 50 with reference to the stop shoulder 34 whereby turning of the wing nut will crowd the hemostat forwardly to crush the tonsil tissue to lessen bleeding but without actually servering it. The severing of the tissues is subsequently accomplished by advancing the knife blade 60 by rotation of the pilot wheel 55 on the threads of the spindle. It will be noticed that the rounded sharpened edge of the knife extends into the sides of the guide slot 26 and being wider than the hemostat blade cannot fail to completely sever all tissue engaged by said blade as the knife reaches the limit of its movement and passes beyond said blade.

Disassembling the instrument for cleaning and sterilization is extremely simple. Restoring the wing nut 5| disengages the cam 50 from the stop shoulder 34 and upon depressing the latch lever the movable parts may be retracted to simultaneously retract the spindle sleeve 41 from the housing an and disen age the wings 31 on the hemostat blade from the undercut guideways 28, :whereupon the connected blades may be dislodged from the frame by moving them laterally through the opening 32 at the side of the housing. Further separation of the two blades is accomplished by springing the slide 62 sumciently to disengage the slot 64 from pin ll and then swinging the flanged end 65 away from the pilot wheel. These parts being thus disconnected permits the withdrawal of the knife blade from the guide slots 38 and its disengagement from the pin 63 on said slide.

I claim:

1. In a tonsillectome, the combination with a frame for insertion in a patients oral cavity having a flat upper face, the outer end of which is provided with an aperture, a rim surrounding the aperture and. comprising side portions extending rearwardly thereof above said face, said rim being provided in its side portions with undercut guideways, of a hemostat blade fitting between the side portions of the rim, lateral wings thereon engaging said guideways and also having guideways therein b low the hemostat blade, said hemostat blade having an arm for advancing and retracting the blade supported above the frame face, a knife blade supported in the last mentioned guides having a rearwardly extending flexible tail piece, a slide for advancing and retracting the knife lying between the arm and the frame and detachably connected to said tail piece and m ans at the outer end of the frame for mani ulating said arm and slide longitudinally on the frame.

2. In a tonsillectome, the combination with a frame piece for insertion in a patients oral cavity having a straight upper face provided at its distal end with an aperture and a rim extending above the face surrounding the outer side of the aperture and extending rearwardly of the aperture at each side thereof, said rim at its sides and adjacent said aperture being undercut to provide sets of guideways for a hemostat blade and a knife blade respectively, of a hemostat blade fitting within the rim, wings thereon engaging one of said sets of guideways, said wings and hemostat blade also being slotted crosswise to provide guideways alined with the knife blade guideways in said rim, a flexible knife blade carried in the hemostat blade guides having a tail piece projecting rearwardly of the latter, an arm overlying the frame face attached to the hemostat blade, a slide member lying between the arm and frame and detachably connected to said tail piece stud on the housing, a hemostat blade and a knife blade guided for longitudinal movement on the frame across said aperture and extending at their rear ends beyond the housing, said knife blade being longitudinally movable relative to said hemostat blade the hemostat blade comprising an arm having a rotatable spindle extendng through the housing, a, sleeve on the spindle having a longitudinal slot to receive the housing stud to permit its insertion forwardly longitudinally in the housing and provided with a cam surface for engagement with the stud to advance the hemostat blade upon subsequent rotation of the spindle and a separate means for advancing and retracting the knife blade.

l. In a tonsillectome, the combination with frame piece for insertion in the oral cavity having a stra ght face provided with a pillory aperture at its distal end, of a hollow housing on the proximal end of the frame supported at one side of its face and open at the opposite side of the frame, a hemostat blade and a knife blade carried thereon each comprising narrow arms insertable through the open side of the housing and gu ded on the frame for movement across said aperture, said knife blade being longitudinal- 1y movable relative to said hemostat blade an inwardly projecting stud on the housing, a spindle journaled on the hemostat arm, a sleeve thereon provided with a slot which permits the sleeve to be inserted in the housing and having a cam surface arranged to subsequently cooperate with the stud to advance the hemostat blade and separate means for advancing and retracting the knife blade.

5. In a tonsillectome, the combination with a frame piece for insertion in the oral cavity having a straight face provided with a pillory aperture at its distal end, of a hollow housing on the proximal end of the frame having an inwardly projecting stud at its rear portion, a hemostat blade comprising an arm overlying the face of the frame, a, spindle on the arm concentric with the housing carrying a sleeve having a slot cooperating with the stud to initially position the sleeve in the housing, a cam surface leading away from one side of the slot and also cooperating with the stud to advance the hemostat arm and move its blade across the frame aperture upon rotation of the spindle, a knife blade carried by the hemostat blade and longitudinally movable relative thereto, independent means for advancing the knife, a spring operated latch mounted on a recess in the frame having a projection alined with the end of the hemostat arm to limit its rearward movement, and a finger trip on the latch overhanging the rear of the frame.

-6. In a tonsillectome, the combination with a.-.

frame piece for insertion in the oral cavity having a straightface'provided with. a pillow aperture at: its distal end, of a hollow housing on. the

proximal. end of the. frame having an inwardly projecting stud at the. top center ofitsrear end, a hemostat blade comprising an arm: overlying the" face of the frame, a spindle on the; arm

concentric with the housing carrying. a sleeve having a slot cooperating with the stud toinitially position the sleeve in the housing and alsohaving a downwardly and rearwardly inclined surface on its under side, a cam surface leading away from one sideof theslot andv also cooperating with the stud to. advance the hemostat arm and move its blade: across the frame-aperture upon rotation of the spindle, a knife bladecarriedby the hemostatblade and longitudinally movable relative thereto, independent meansfor advancing the knifea spring operated latch mounted ina recess intheframe, having a projection alined. with the end of the hemostat arm to limit its rearward movementandbearingupon said. inclined surface teyieldingly resist forward movement of the .hemestat arm and the parts carried thereby.

7.. In a tonsillectome, the combination with a frame; for insertion in an oral cavity having av straight upper face provided at its distal end with a.- pillory aperture and. at its rear end witha downwardly extending handle and having a slot in said face opening atithe-rear side of the handle, of ahollow housing overhanging said. face. at its rear end having a stud projecting. inwardly from the housing, ahemostat blade having. an

arm overlying and spaced from said frame-,. a spindle onsaid arm concentric to the housing, a sleeve thereon having a longitudinal slot registering with the stud. and a camsurface for also cooperating withthe stud; said sleeve also having an inclinedsurface on its side which. is undermost when. its slot is initially engaged with thestud, a cutting blade carried on the hemostat blade and. a slide for operating it located between the hemostat blade-arm and theframe and-havingv a longitudinal opening registering with-the recess in the frame, a spring operated. latch located. in said recess and operating. through. the slide opening comprising a projection cooperat ing with the end of the hemostat arm to arrest its. rearward movement and also bearing againstthe inclined. surface of the sleeve to yieldingly restrain. the forwardmovement. of the arm. and a thumb. plate on the free end of the latch at the:v top of the handle forretractingv the-latch into an inoperative position.

OSCAR C. DANIELS, SR.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Name Date: Stadle r. Aug, 20,1949

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